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Guest editorial by Matthew F. Powers, MS, BSN, RN, MICP, CEN, president of the Emergency Nurses Association, the leading nursing association serving the emergency nursing profession through research, publications, professional development, and emphasis on quality and patient safety.
A trip to the emergency department can be a stressful event for any patient just given the fact they are sick or injured. As emergency nurses, we are on the front line helping patients to remain calm and get the care they need. But what happens when something avoidable goes wrong and it turns into an even more traumatic situation? For a transgender patient, this is often a reality.
According to a 2011 study (Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 2011), nearly 30 percent of transgender people report harassment or violence during their medical visits, and 33 percent of transgender people postponing medical care as a result of these implications and dangers.
These statistics are unacceptable. It's crucial for us, as emergency healthcare professionals, to provide care to transgender patients that's proactive, accurate, compassionate and considerate, as we strive to treat all patients the same without judgement
In fact, new research from the Journal of Emergency Nursing highlights the importance of acting appropriately when caring for transgender patients in the ED. The article chronicles the experience of Brandon James, (a pseudonym), in an American ED in 2015. According to the case study, the patient's ED visit was filled with situations that a transgender person might experience with ED personnel who are unfamiliar with treating transgender patients.
For instance, James, a masculine transgender man who transitioned using hormone replacement therapy five years before his ED experience in 2011, describes his check-in process as humiliating. When James presented his driver's license, which identified him as a female, he was met with staff debating his gender aloud and pulling in an additional two to three people to assist him. This occurred despite the fact that his electronic medical records from previous hospital visits included female gender markers. James describes feeling like a "freak show at the circus."
After waiting several hours to be treated, a nurse who listened to James' friend recount the check-in experience apologized and validated their experience. It's critical for all nurses to take actions like this to make sure every patient's dignity is preserved.
James' story identifies new implications for emergency nursing practice when treating a transgender person, as nurses today care for an increasing number of transgender patients. Nurses and their ED colleagues must understand how to give these patients the care and respect they deserve.
Here are a few important takeaways from James' story that emergency nurses should consider when caring for transgender patients in the future. Nurses should take these steps to provide a high-quality and comfortable experience for the transgender patient:
Ask the person how they would like to be addressed. In the case of Brandon James, many insensitivities could have been avoided if the ED staff member asked the patient how he would like to have been addressed.
Use the proper pronoun. When speaking to a transgender patient, use the pronoun that matches the gender to which he or she currently identifies.
Keep conversation clinical. Only ask clinically relevant questions during the examination of a transgender patient as one would with all patients.
Be sensitive to shared spaces. When taking a transgender patient into an area of the ED where he or she might share a space with another patient, keep gender to which he or she identifies, top of mind.
Lead by example. Because nurses are on the front lines of patient care in the ED, they should take a leadership role in showing respect to all patients regardless of how they identify themselves, and step in to help defuse any sensitive situations they observe.
James' story is told in the article, "I Was a Spectacle...A Freak Show at the Circus: A Transgender Person's ED Experience and Implications for Nursing Practice," to prevent similar events from happening in EDs across the country. You can find the full article here.
Guest editorial by Stacy Slater, MSN, BS, RN-BC, Revenue Cycle Coordinator, Munson Healthcare, Traverse City, MI
Pay-for-performance, value-based purchasing, the triple aim of healthcare, HCAHPS, volume to value - Nurses need, at the very least, a rudimentary understanding of these terms and how the care they provide directly affects reimbursement and how reimbursement impacts the care they provide to their patients.
What is this: The two main goals of the Patient Protection and Affordable Care Act of 2010 are reforming health insurance (the Marketplace) and reforming delivery and payment systems (pay-for-performance). Pay-for-performance is the reimbursement model that Medicare is using to drive the triple aim (improved value, improved outcomes, and improved patient experience). Value-based purchasing is just one of the elements of pay-for-performance.
What does it mean and how does it impact nursing: Value-based purchasing (VBP) is a method of payment that involves penalties or incentives. This method allows CMS to "purchase" value when it pays for healthcare versus paying for services based on volume or "fee-for-service." Currently, all healthcare providers that participate with Medicare are transitioning from volume to value. One of the measures of the VBP program is patient experience. The patient satisfaction scores, measured via the Hospital Consumer Assessment of Healthcare Providers and System (HCAPHS), surveys inpatients post discharge and includes questions that are directly related to nursing care. Questions such as nurse-patient communication, how well pain was controlled, quietness and cleanliness of the patient's room, how well discharge orders were understood, responsiveness of staff, and communication about medications. The quality of care that nurses provide can be measured and can be positively reflected in patient outcomes and payments received by the health system. This collaboration between nursing and finance can lead to improved patient outcomes and improved value.
In her blog, Pamela Austin Thompson, chief executive officer of AONE, eloquently states the need for nursing and finance to be on the same team. To prevent patient care from becoming secondary to reimbursement, we need nursing professionals who understand finance and the financial impact of clinical decisions, and financial professionals who understand how cost-reduction measures impact the delivery of patient care.
This is our time to shine and step out front - nurses and the quality of care that we provide can improve the value of care, improve patient outcomes, improve the patient experience and in essence be the drivers of healthcare reimbursement.
Editor's Note: This guest post is written by Veronica Gutchell, DNP '13, RN, CNS, CRNP, assistant professor, University of Maryland School of Nursing
On any given night, about 3,000 people in Baltimore experience homelessness. To help with this ongoing problem, University of Maryland School of Nursing (UMSON) faculty members Katherine Fornili, MPH, RN, CARN, assistant professor, and Rosemary Riel, MAA, clinical instructor and associate director, Office of Global Health, and I participated in the Baltimore City Point in Time count last winter. We worked with both sheltered and unsheltered individuals. The data from the count is used to advocate for resources, plan programs, implement policies to address homelessness, and evaluate the use of existing resources and programs.
I came upon this opportunity through the Global Health Certificate program at the University of Maryland School of Nursing. The Global Health Certificate program helped me think about my practice through the lens of social justice. It challenged me to understand my own biases and how they impact my practice as a nurse practitioner. Using the lens of social justice changed the way I work with underserved patients in primary care.
We spent a lot of time in the certificate program focusing on the social determinants of health and then we applied those concepts in a field placement experience. Going abroad for four to six weeks didn't work for my life at the time, so I asked for the opportunity to practice applying the social determinants of health locally.
My assignment addressed the issue of homelessness in Baltimore. Through the faculty's network of contacts, I was introduced to some very talented people at Health Care for the Homeless, a nationally-recognized model for the delivery of health care to those experiencing homelessness. Through Health Care for the Homeless, I was able to work on a project to start up a mobile clinic program. The mobile clinic delivers primary health care to those experiencing homelessness in Baltimore and surrounding areas.
In researching my project proposal, I came across 2013 data from the Mayor's office on the Baltimore City Point in Time Count. After my field placement was completed, and I presented my experience, a colleague talked to me about volunteering for the next Count. I was immediately interested in organizing volunteers from UMSON, so I sent an email to the School's faculty and staff announcing a service opportunity. Nine people responded and three of us ended up being able to participate. The organizers needed most volunteers for the overnight count and it turned out that the three of us were able to volunteer for both nights.
The Count involved conducting a survey to try to better understand who experiences homelessness. For example, from the 2013 Count, 52 percent of respondents reported a history of mental illness, 56 percent a history of substance abuse, and 11 percent indicated they were veterans. This information helps communities determine how to tailor services to those in need.
Questions on the 2015 survey looked at mental illness, substance abuse, Post Traumatic Stress Disorder, and veteran status. Additionally, there were questions about previous experience with trauma and how long an individual had been experiencing homelessness. Almost every person I surveyed agreed to participate. I even had one individual who was sleeping on the street in 27-degree weather say "God bless you."
The experience of homelessness can seem overwhelming. Even so, I feel optimistic about the goal of making homelessness "rare and brief." Journey Home Baltimore, the organizers of this event, estimates over 300 people volunteered to help with the 2015 count. I'm hopeful because there are a lot of people who cared enough to come out in the middle of two cold winter nights to conduct this important survey. The volunteers were a widely diverse group of community members; for me, there's something moving and promising about that. I am inspired by those who dedicate their professional lives and those who volunteer to make homelessness a temporary experience for individuals and families. It's that work and commitment that keeps me encouraged.
I fully support the idea about leveling "the playing field" when it comes to requiring advanced degrees for nurses to practice. I believe that my advanced education has greatly improved my nursing care; however, there is very important aspect related to this debate that is often neglected.
One of the problems with requiring advanced degrees for nurses, is, according to the American Association of Colleges of Nursing (AACN), we not only have a nursing shortage but a faculty shortage as well. As a recent nursing faculty member, I can tell you that I worked in one of at least 700 nursing schools with vacant faculty positions (http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage). Although the average salary of a nursing instructor is slightly over $78,000 per year, I was making a little more than half that amount and working every day of the week to prepare my students for the workforce. When my students graduated and obtained a job, they made more money than I did. A nurse practitioner, who also requires a master's degree, averages over $91,000 per year (http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage).
Compensation, although important, is not the most important aspect of a career. As I previously stated, I worked every day. I am an organized person by nature, but not only were there papers to grade and research to be done in order to prepare for lectures and clinical experiences, in an academic setting service is a requirement of scholarly research and publication in order to gain promotion. There were often marathon faculty meetings as well as hours of advising of students. Most of the time, it feels like you don't get to spend enough time with working with the students which is the whole reason you started teaching. People say, "Well, you get the summer off." Again, we are doing research, service and preparing for the next academic year. We are volunteering at new student orientations and academic advising for the incoming freshmen and transfer students.
I am not complaining about the job as I loved spending time with students, but I am trying to show that there is much more to being a nursing faculty member than working 12 hours and then going home. (I'm not saying that working a 12 hours shift in a hospital is not difficult). I also have a spouse and four children. I had to stop working as a nursing faculty in order to be present with my family. I now have a part-time nursing position in which I spend 24 hours and make more money per hour than I did as a nursing faculty.
The compensation for the amount of hours that a nursing faculty is required to spend is not adequate. Until this is remedied, requiring advanced degrees for nurses is going to be an uphill climb. It's a wonderful idea and has been shown to improve patient outcomes, but thought needs to be put toward nursing faculty retention and compensation in order to make advanced practice degree requirements work.
After 30-plus years in nursing, I've accumulated plenty of stories. You get it, if you've been in nursing for a while. Like for at least a week.
In the first decade, nursing experiences floated through my mind like sand pebbles dumped from shoes after an afternoon at the beach. I was aware of them, but didn't put them much into conscious thought, since my brain was already figuring out a grocery list for the way home and wondering if pizza and ice cream for the fourth night in a row was really such a bad thing. Wait. There were a few outstanding memories - some of us who have been nurses for a long time will recall - when being hollered at by a doctor was not uncommon, when working night shift meant cleaning up the floor after a delivery and checking on mom and baby in between swipes of the mop. And, of course, there are the tender recalls of the gift of truly being present with a patient, the basics of helping, which brought most of us into the profession in the first place.
There have been controversies around union issues, the transient, occasional lateral violence between nurses ... there are probably few experienced nurses today who don't have stories to tell.
Then came the big insurance changes - more restrictions on hospital stays, the advent of prior approvals for treatments and certain medications, often shifting the day-to-day focus of nurses. For me, time spent with patients was greatly reduced due to increased time on the phone with insurance companies and an increase in staff meetings largely focused on keeping up with regulations and the changing systems required to do that. At times, it all seemed so ridiculous. BECAUSE IT WAS.
It wasn't long before I began to imagine humorous scenarios beyond the agony. It was either that, or consume large quantities of chocolate at eight in the morning. Sitting through what once seemed largely patient-focused meetings now felt like board meetings, with graphs and charts and outcomes - yes, there were lots of numbers. Big numbers, small numbers, scary numbers. The way of corporate thinking had reached medicine in a big way. I'd look around the room: 20 or 30 professionals crammed into a classroom, eyes glazing over watching a powerpoint presentation filled with statistics. It made me want to run home to take a shower. Soon, I couldn't help myself from looking at nearly everything more critically, and thankfully, with laughter. For now, I was also dealing with my the middle years, complete with aging parents, a child still in college, my inability to say no when someone needed a favor ... and I began to imagine "what if" scenarios. I confess I may have missed a few of the important facts of some of the unending "initiatives" at these meetings. But using humor as a tool for coping with the boredom and get-me-outta-here thoughts each time actually gave me all the more smiles and charity for when I did - finally and blessedly - get to actually interact with a patient.
Not Even Dark Chocolate Can Fix This Mess is fiction. It's the wildly, silly story of a woman who nurses by day and crams her overwhelmed life into the rest. She gets roped into doing a good deed for her niece and in her constantly-overwhelmed state, ends up making a huge, embarrassing mistake. Even though she's tried all that deep breathing stuff. Friends, you will learn nothing from this novel. But it will give you some much-deserved laughs. You've earned it.
Now, pay attention to the powerpoint. And nod slowly up and down. It looks good.
Editor's Note: This guest post is written by by Nancy C. Lee, MD, deputy assistant secretary of health - women's health, and director of the office on women's health at the Department of Health and Human Services and Ana N. Fadich, MPH, CHES, vice president, men's health network.
Each year we ask women and men to take two weeks out of their routines to make their health a priority. In May, we ask women to take small steps to improve their health during National Women's Health Week (NWHW) (May 10-16). In June, Men's Health Week (MHW) encourages men to get regular preventive care (June 15-21). With NWHW behind us and now that we are in the middle of MHW, it's a great time to talk about how we can all team up for better health the other 50 weeks of the year!
We know that the healthiest decisions aren't always the easiest ones to make. But with support and encouragement from the people we love - particularly our partners and families - making smarter choices is easier. Let's make focusing on healthy behaviors and prevention a team effort. Now's the time to team up with your partner to meet your health goals together. If you are not married, partner with a family member, friend, or coworker! Having someone else who is committed to the same things will make it easier for both of you to stick to a healthier lifestyle. Here are some small changes you can make today:
That last one may feel a little strange at first. After all, we're used to the idea of exercising or eating with other people, but going to the doctor? There are benefits, though! If you're someone who feels anxious around doctors, knowing your partner is doing the same thing can give you much-needed support. If you have a hard time remembering what your doctor told you to do, talking it over with your partner afterward can help you keep track of the information. All women and men - even if they feel fine - need to receive routine care. Your annual checkup is a time to talk with your provider about how you're doing, how you'd like to be doing, and what changes you can make to reach your health goals. It's also a time to get preventive services and screenings. And thanks to the Affordable Care Act, most health plans must cover a set of preventive services at no cost to you, even if you haven't met your yearly deductible. For a complete list of covered services for adults, visit http://www.healthcare.gov/. When you and your partner take steps for good health, not only are you helping each other stay healthy for the long-haul, but you're setting a positive example for your kids. It shows them that health is important and it's okay to talk about it. In fact, you should talk about it. Build an open line of communication with your kids, and help them feel comfortable coming to you with questions about their health. It's time we made health a family affair this week and every week. When you're healthy and happy, everyone wins!
Editor's Note: This guest post is written by Christine W. Clarke, RN, MS, ONC, educator, Houston Methodist Orthopaedics
When I reflect on the elements which persuaded my decision to become a nurse, I cannot ignore hereditary influence. Between my maternal grandfather's aunt serving with Florence Nightingale during the Crimean War and three of my aunts graduating as diploma nurses after WW II, I would say my genes are pretty entrenched in a passion for nursing!
My first job during college was working as a weekend secretary on an orthopaedic ward at a major medical center hospital in the northeast. It was then that I grew to admire the spirit of the "floor" nurse who wore a starched white uniform, nurse's cap, white stockings, white shoes, and a navy blue cape clasped at the neck worn during cold, snowy weather. I was in awe of how that uniform stayed a pristine white after an eight hour shift! Those nurses worked diligently to nurse adult patients with complicated musculoskeletal conditions. I loved to sit at the bedside with some of the long-term patients to listen to their stories. The head nurse wore many hats. She was the medication nurse who poured meds in the nurse's station from a locked wooden cabinet. She was acutely aware of each patient's condition and was prepared to give a succinct report to every attending MD at 0800. She also oversaw the role of the RN as they performed the patient assessment, dressing changes, and prepared the patient for surgery. The LVN answered to the RN, and there were no patient care assistants. The LVN took vitals, measured I&O's, turned scoliosis patients on Foster frames, monitored patients in restraints, and was expected to bathe every patient, while still having time to autoclave metal bedpans before the end of their eight hour shift. The nurse did it all and I was so excited to be a small part of their team!
Although I was told, "You should have been a nurse" many times during my life, I don't think I seriously considered going into the nursing profession until I experienced a life-changing event which happened to me as a patient at Houston Methodist Hospital. As an adolescent, I developed a chronic hip condition which leads to significant arthritic pain and immobility. The predictable treatment was total hip replacement. I was encouraged to wait as long as possible to receive the most reliable implant which would improve my quality of life, a life without chronic arthritic pain. A nurse from our church recommended a well-known, highly respected orthopaedic surgeon at Methodist. At 40 years old, I underwent hip replacement surgery. I remember waking up in a private room, surrounded by my family; and best of all, I was free from hip pain!
My nurses were experienced orthopaedic nurses who exhibited a kind, and caring passion in the art of nursing. I trusted them with my life. Because of my positive experience from an inpatient perception, I felt a strong urge toward following the Golden Rule, that is, to "give back." Could I be a nurse? My hip was fixed, but I was unsure I could endure the physical demands required of a nurse. My final nudge was from my husband who said, "There is nothing wrong with your brain - go back to school and become a nurse." That gentle push was what I needed to fulfill my need to give back to those who changed my life.
I have since graduated with my Master's degree and have shared my personal story thru pre-operative teaching to hundreds of elective joint replacement patients which have included nurses, pharmacists, physicians, and high-profile individuals.
As I approach the age of retirement along with many of my nurse colleagues, I urge graduate nurses to consider entering the specialty of orthopaedics. There is no question that nursing is a stressful profession. The orthopaedic patient population envelopes many more co morbidities which go hand in hand with chronic and acute musculoskeletal disorders. Arthritis may be accompanied by the challenge of immobility and obesity, drug or alcohol dependency, depression, hypertension, and/or diabetes. Mobilizing ortho patients may be physically exhausting; but the rewards of watching a patient walk straight and tall, with minimal pain, just a day after surgery, allows one to quickly forget how physically demanding ortho nursing can be. I can only hope that sharing my experience has made a difference!
By Corina Wilkin, BSN, RN
The American Organization of Nurse Executives (AONE) and Emergency Nurses Association (ENA) recently held a 'Day of Dialogue' to discuss how incidents of violence are currently addressed in hospitals. AONE includes lateral violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse) in their definition of workplace violence. According to the Workplace Bullying Institute (WBI) workplace bullying is partially defined as repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct that:
"Being bullied at work most closely resembles the experience of being a battered spouse. The abuser inflicts pain when and where she or he chooses; keeping the target (victim) off balance knowing that [lateral] violence can happen on a whim, but dangling the hope that safety is possible during a period of peace of unknown duration. The target is kept close to the abuser by the nature of the relationship between them -- husband to wife or boss to subordinate or co-worker to co-worker," (WBI website).
The WBI states that the "most easily exploited targets are people with a desire to help, heal, teach, develop, and nurture others. Targets generally do not respond to aggression with aggression. But the price paid for apparent submissiveness is that the bully can act with impunity (as long as the employer also does nothing)." According to the 2007 WBI - Zogby Survey, 45% of targeted individuals suffer stress-related health problems. WBI reports that victims suffer negative consequences to end the abuse as follows:
As a victim of workplace bullying, I can relate to other WBI. When I have talked to my direct supervisor about these issues, she has spent time counseling me to improve my response to my bullies. This leads me to question my own behavior when it is not my behavior that is the problem. The most recent bullying incidence involved a coworker popping a latex balloon in my presence and announcing to our entire office that people with latex allergies should not be in the office. Yes, I have a latex allergy. When I complained to my boss she asked what I could have done differently. The 'dream job' has turned into a living nightmare.
I have a history of childhood bullying. The cumulative effects of a childhood history pockmarked with bullying along with the past 20 months of being victimized in the workplace has led me to withdraw a little more every day. I suffer because of my bullies' behavior. According to the WBI that is generally the case. They wrote that only 11% of perpetrators experience negative consequences (5% terminated, 6% punished) resulting in a 'no consequence rate' of 89% for bullies."
I have myriad questions. Questions a battered spouse likely asks him- or herself.
Every day it is a little harder for me to come to work. As my family's primary wage earner, I don't have the luxury of removing myself from the situation without making provisions. And the longer I stay the more the harmful effects accumulate and whittle away my professional sense of self as well as my sense of safety in the workplace.
Hell, what am I talking about? I have no sense of safety in the workplace. I know another attack is coming. But I am not ready for it. I will never be ready for it.
American Organization of Nurse Executives, Mitigating Violence in the Workplace, http://www.aone.org/resources/PDFs/Mitigating_Violence_GP_final.pdf 2014
Workplace Bullying Institute, http://www.workplacebullying.org/individuals/problem/being-bullied/, 2014
Editor's note: Guest blogger Samer Koutoubi, MD, PhD, is program director and faculty member, public health at American Public University
The health and well-being of Americans should be the top priority of Congress. So why is Congress considering removing $900 million in public health funding from the Centers for Disease Control (CDC) in FY 2016?
The proposal to repeal the Prevention and Public Health Fund will make public health professionals weak and unable to protect the health of our people and communities. This is unacceptable.
The deep cut in FY2016 will reduce and/or remove existing funding for key preventive services and programs for chronic diseases such as obesity, cardiovascular disease and stroke, diabetes, and cancer. This will be disastrous for our country, especially for low-income Americans, and other who benefit from the Supplemental Nutrition Assistance Program (SNAP).
Dr. George Benjamin, American Public Health Association executive director said, "In the face of fiscal pressures, we look forward to working with the administration and Congress to reverse austerity measures that prevent adequate investment in programs that promote and protect public health."
What we need to do?
Nurses and other health care professionals - as well as patients and others who will be significantly impacted by these cuts--should contact local, state, and federal officials and tell them to invest in the public health system to save lives and money. These funds are needed to keep America healthy.
While the new 2016 proposed budget has deep cuts in key public health programs, new programs have been funded especially in the areas of global health security. For more information, please visit the U.S. Department of Health & Human Services HHS 2016 budget, visit www.hhs.gov/budget.
Editor's Note: Guest blogger Ronda McKay, DNP, CNS, RN is chief nursing officer and vice president of patient care services at Community Hospital, Munster, Ind.
My recent article - Using Technology to Enhance Nurse Safety - generated quite a bit of response from members of the nursing community. The discussion is important, as such discourse helps to move our profession forward. I would like to take this opportunity to emphasize some points that I think should be added to this conversation:1. Safety is an important concern for all healthcare workers, especially nurses. According to Top 10 Patient Safety Concerns for 2015, a recently released report from ECRI Institute, a non-profit research organization, "managing patient violence" should be a top priority for all healthcare organizations. Our organization, Community Hospital, Munster, Ind., is addressing this important challenge, and others should follow suit. The button on the real-time locating systems (RTLS) badge allows our nurses to summon help immediately when faced with patient violence. The system also helps to improve nursing workflow - patient calls are automatically cancelled when the nurse enters the room, so the nurse focus on the patient rather than the button on the wall.
2. The use of RTLS is just one of a variety of initiatives that we have in place to keep workers safe. It is a single, but important, component of a multi-faceted security program that includes a variety of strategies and technologies designed to keep our staff safe.
3. Healthcare organizations need to create healthy working environments for their workers. Leaders and managers need to communicate freely and openly with staff about workplace practices, policies and procedures. Perhaps more important, though, leaders need to abide by the "actions speak louder than words" rule and make sure their organizations not only talk about but actually nurture environments of trust. Indeed, it's this communication and follow-through that leads to a healthy and happy work environment, not the fact that an organization does or does not use a particular technology - such as RTLS.
4. We fully understand the "big brother" concerns associated with RTLS. That's why we clearly spelled out the expectations and intended purpose for using RTLS before implementing the system. Even more important, organizations then need to actually use RTLS in the expressed manner (i.e. to improve workflow, enhance safety or track assets - not to monitor employee breaks or keep tabs on employee movement). For example, if an organization adopts RTLS in an effort to improve workflow - and then uses the technology to make it possible for clinicians to spend more time at the patient bedside, the RTLS will be warmly embraced. Of course, if an organization does monitor clinicians' break time and uses the information in a punitive manner, clinicians will quickly dismiss RTLS, and the benefits of the system will never be realized. Overall, when RTLS is implemented to accomplish specific goals - and then is only used for this express purpose - concerns about the technology being used to covertly keep tabs on workers quickly dissipate.
In sum, succeeding with RTLS, as with any other technology, takes much more than simply implementing the solution. To truly benefit from any innovation, organizations need to create and nurture a culture that can truly support the use of technology solutions for the greater good.
Earlier this May, at ASCLS-Pennsylvania's state meeting, I attended an educational session entitled, "When Professionals Meet: Bridging the Gap between the Laboratory and Nursing." Like most medical laboratory professionals, my opinion of nurses isn't exactly a positive one. So, I was intrigued to hear what the speaker had to say. The presenter was Lucinda Manning, who works in the immunohematogy reference laboratory at ARUP laboratories. Interestingly, Manning is certified as both an MLS and an RN. Unlike us lab techs hidden away in the basement or the nurses up on the floors, Manning has experienced both sides. Seeing her credentials, I figured that this woman may have the answer to the age old question on why lab professionals and nurses just can't get along.
The humor website Uncyclopedia's page on medical laboratory scientists, describes nurses as, "the med tech's arch nemesis and rival." Although you may wholeheartedly agree with that statement when you are being yelled at by a nurse over the phone, it is statements like these that only further create a divide between the two professions. Manning told us to think of a hospital like a wheel with each spoke being a different category of hospital personnel. Then she told us to imagine how the wheel would work if you took one of the spokes away. It was easy for us to imagine how taking away the lab would affect the hospital: no lab, no results. We soon realized, however, that every other personnel area was equally as important as the lab.
The thing Manning stressed in her presentation was that nurses and lab professionals are very different, but we both have a major thing in common and that is our concern for our patients. Often times, we accuse one other of not caring for the patient, but it is not that either side neglects the wellbeing of the patient; we just show we care in different ways. For example, a lab person will not report out a result until they are confident their instrument is working properly through the use of QC. On the flip side, a nurse wants to quickly determine a care plan for their patient so they can get them on the road to recovery. Our intentions are the same, but the different styles of thinking between nurses and the lab causes things to become lost in translation.
Recently, an article entitled, "13 Things this Lab Scientist Wishes Every Nurse Knew," went viral among lab professionals. While every bullet point in the article has crossed my mind numerous times, the truth is that I have the upmost respect for nurses. I know that they are up there on the front lines dealing with patients every day, and I know I could never do what they do. The bottom line is everyone's main concern is the patient, and the only way our patients can receive the best care is if we all work together and respect each other.
By Jamil King, National Sales Manager, Panasonic
As the role of nurses has evolved throughout the years, so too have the mobile computing tools they depend on in the fast-paced healthcare environment. Being on the front lines of patient care, nurses have often been the early adopters of different technology to aid in delivery of patient care - from beepers to "computers on wheels" to PDAs. As faster information retrieval and better documentation tools have become imperative in the healthcare industry, many are looking to next-generation mobile computing tools to increase productivity, reduce costs, and provide more accurate and efficient patient care.
Despite the excitement around mobile computing in the mHealth arena, 93% of nurses in for-profit facilities stated they do not have computers in each room or hand-held/mobile devices to aid in the EHR requirements, according to the Q3 2014 Black Book EHR Loyalty survey. This lack of IT resources has a dramatic effect on nurse workflow patterns and inevitably leads to time taken away from patient care. In this environment where all staff are driven to operate at the top of their license, every minute of time savings and every improvement in accuracy and efficiency is critical to improving outcomes.
Recent innovations in mobile computing technology are the physical manifestation of the industry's rapid rate of change - from 4K displays to view medical imagery more clearly, to integrated barcode readers to use in medication management, to smaller and lighter tablets that fit in a pocket but offer the same processing power as a desktop computer - every new innovation addresses a genuine concern identified by the preceding group of healthcare professionals. Every move the industry makes toward providing nurses with effective mobile computing solutions translates into better, more efficient patient care.
As mobile computing has evolved over the years, equally so has nursing as a career. Nurses are now not only providing care, but working behind the scenes in IT purchasing and implementation, as well. A 2014 survey of more than 3,000 nurses found that 70 percent of respondents agreed nurses play an important role in medical device integration. With this in mind, a relatively new specialty has evolved - the nursing informatics specialist, a discipline that "integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice," according to HIMSS. It is clear informatics nurses will continue to be instrumental players in the analysis, implementation, and optimization of advanced information systems and emerging technologies that aim to improve the quality of patient care, while reducing costs.
As nursing professionals continue to excel within the healthcare industry at all levels of leadership, their understanding and acceptance of technology will continue to propel the use of digital tools, mobile computing included, into an integrated health experience. Nurses know that mobile, point-of-care computing solutions provide a way to effectively leverage information technology to advance both clinical productivity and patient care quality.
Interested in the growing importance of informatics nurses in the healthcare information technology environment? Check out the 2015 HIMSS Impact of the Informatics Nurse Survey to view the full results and infographic.
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Guest blogger Rebecca Bone, MSN, RN is assistant professor, Tennessee State University
Indeed, a nursing faculty shortage exists within nursing programs across the nation. Many institutions of higher learning are choosing to fill nurse educator positions with advanced practice nurses, in particular, nurse practitioners. As this may appear to be a quick fix for a serious problem, filling educator positions with individuals that lack formal nursing education curriculum presents a number of challenges for practitioners as well as students.
Nurse Practitioners definitely possess exceptional clinical knowledge, but many quickly discover they are treading on unfamiliar territory when attempting to enter the nurse educator arena. Often, they lack the skills to effectively communicate knowledge for student learning to occur. Most students complain that practitioners have a tendency to teach above the level of the average nursing student's comprehension. Frequently, nurse practitioners assume the student has prior knowledge of certain content, when in fact, sufficient learning has not occurred which hinders the student from progressing to higher level concepts. This false assumption retards student learning.
Nurse practitioners who lack formal training in nursing education struggle with the daily responsibilities of the nurse educator role. Many do not understand the theoretical concepts of teaching and learning, much less using Bloom's Taxonomy to guide item writing to effectively evaluate student learning. They certainly are baffled when asked to link course learning outcomes with program learning outcomes. These are essential skills that must be mastered in order to be an effective nurse educator. Practitioners know what the NCLEX is, but don't understand the importance of the NCLEX blueprint. Therefore, practitioners frequently experience and express frustration when assuming nurse educator roles without acquiring formal knowledge.
The purpose of post article is to enlighten practitioners who are contemplating nurse educator positions to the challenges that have been observed and reported. Many have a false sense of the nurse educator role, not realizing that it is common practice to devote evening and weekend hours for lecture preparation and/or examination construction. In addition, nurse educators are expected to participate in university activities, be active members of professional organizations, and engage in research. Thus, the role of the nurse educator can be very overwhelming at best and most often undervalued.
By Rose Sherman, EdD, RN, NEA-BC, CNL, FAAN
Research reported in March 24/31, 2015, issue of JAMA has opened a nationwide discussion about the pay inequality in nursing. The study findings indicate that male nurses make on average $5,100 more than their female colleagues. The data was drawn from National Nursing Samples conducted between 1988 and 2008 and American Community Surveys conducted between 2001 and 2013. The research team included two RNs - Dr. Ulrike Muenich from the University of California and Dr. Peter Buerhaus, a well-known workforce researcher at Vanderbilt University Medical Center. While none of the surveys used were originally targeted to look at pay inequity, the researchers were able to control for demographic differences, job position, hours worked and a variety of other factors as they evaluated pay.
The salary gap existed in all specialties except orthopedics and all positions including management. The monetary differences ranged from a low of $3,792 in chronic care to a high of $17,290 in nurse anesthesia. The study has limitations in that only 7% of the total sample were men. No specific reasons for the inequalities were identified. Nursing experts have speculated that men may be better salary negotiators, women may take lower paying positions with more flexibility to raise children, and some organizations may offer higher salaries to male nurses to diversify their workforce. This is the first study published on this topic and more research is clearly needed.
Although there may be missing pieces to the puzzle, the research findings provide compelling evidence that there are pay inequalities in nursing. This is a troubling trend in a predominantly female profession long believed to offer equal opportunity to both sexes. It has resulted in a call to action from leaders in professional nursing associations for Executive Nurse Leaders in organizations to review wage data by gender for employees in equal positions with comparable experience to identify any bias in pay. Likewise, female RNs seeking positions should do more due diligence in organizations to insure that there is pay equity for both sexes.
There is a sense of urgency to rectify this problem. With 3 million Baby Boomers turning 65 each year between 2014 and 2034, it is anticipated that Generation Y (born 1980-2000) will be 50% of the nursing workforce by 2020. Workforce shortages are anticipated across all specialties. Generation Y nurses look to work in healthy environments where there is leadership transparency and equity in how they are rewarded. Their technological abilities and the availability of websites such as www.glassdoor.com will enable them to more easily identify organizations where there are pay inequities between men and women. If they find inequality, they are more likely than any generational cohort that preceded them to leave an organization and seek other opportunities.
Wise leaders will look at this research and take action now.
Rose O. Sherman is the Blake Distinguished Professor in Nursing and Director of the Nursing Leadership Institute in the Christine E. Lynn College of Nursing at Florida Atlantic University. She can be reached at firstname.lastname@example.com.
Muench, U., Sindelar, J., Busch, S.H. & Buerhaus, P.I. (2015). Salary Differences between Male and Female Registered Nurses in the United States. Journal of the American Medical Association. 313(12), 1265-1267.
By Violet Edwards, Nursing Student BSN, Medgar Evers College
I wish to convey my concern for the safety of nurses. We are faced with challenges and risks each day on the job and are expected to provide safe quality care, yet our safety is constantly compromised. Latex allergy is still a problem in the hospitals and I am partially happy that you brought this topic to light.
I agree that "nothing in the world can be latex free," but it is imperative that all hospitals aim to be latex safe. Nurses are expected to give safe quality care so therefore their environment should be conducive to such. As stated in the article, latex gloves are not the only medium of allergy for the nurse in the workplace so creating a latex resource nurse to work with the latex committees is not solving the problem.
Some nurses are forced to leave areas that they love because of their latex allergy. They end up in areas that are less fulfilling and hence they get bored and leave the job while the hospital loses a potential great employee. This should not have to happen seeing that there are other alternatives such as being latex safe.
I understand that to make a facility latex safe is costly, but I think that if its done at other hospitals and it works well then all hospitals should adapt the principle. It may end up costing the same or more to put into place the ALAA recommendations than to create a latex safe hospital. It is fair to say that some action is being taken to protect the nurse, but much still needs to be done to ensure that the nurse is safe in order to practice safely.


text:
A big stopper to success in marketing is resistance – when you resist doing your marketing activities. There are blockers like procrastination, perfectionism, and a host of other fears. I'm sure you can name some of your own demons.
Here's a great tool for hacking away at these action-frictions to increase traffic, grow a following, and build your expert image.
The tool: Limit time.
Limit the time you spend on … read on

subset: commoncrawl


text:
|Date / Time
|Tuesday September 15, 2015 @08:52AM
|UK Labour Party's Support For Homeopathy Grows
|Friday July 31, 2015 @06:28PM
|$340 Audiophile Ethernet Cable Tested
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|Thursday February 19, 2015 @07:47PM
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This is the theory that Jack built. This is the flaw that lay in the theory that Jack built. This is the palpable verbal haze that hid the flaw that lay in...


text:
Are you T. Varughese?Claim your profile
Publications (40)56.18 Total impact
Article: Fusion measurements for the &${}^{18}$;O+&${}^{194}\mathrm{Pt}$; reaction and search for neutron shell closure effects[Show abstract] [Hide abstract]
ABSTRACT: Evaporation residue (ER) and fission cross sections were measured for the reaction &${}^{18}$;O+&${}^{194}\mathrm{Pt}$; forming the compound nucleus 212Rn. Fission fragment angular distributions and anisotropies are consistent with the saddle point model predictions. Measured ER cross sections were fitted with statistical model calculations assuming shell-corrected free energy fission barrier height. The non-zero dissipation strength required to fit the ER cross section supports the dissipative nature of fission dynamics in heavy ion fusion. In the present study shell closure effects are not observed in the dissipation strength.Journal of Physics G Nuclear and Particle Physics 09/2015; 42(9). DOI:10.1088/0954-3899/42/9/095105 · 2.78 Impact Factor
- The European Physical Journal Conferences 01/2015; 86:00026. DOI:10.1051/epjconf/20158600026
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract. The characteristics and performance of the newly commissioned neutron detector array at IUAC are described. The array consists of 100 BC501 liquid scintillators mounted in a semi- spherial geometry and are kept at a distance of 175 cm from the reaction point. Each detector is a 5"x5"cylindrical cell coupled to 5"diameter photomultiplier tube (PMT). Signal process- ing is realized using custom-designed home-made integrated electronic modules which perform neutron–gamma discrimination using zero cross timing and time-of-flight (TOF) technique. Com- pact custom-built high voltage power supply developed using DC–DC converters are used to bias the detector. The neutrons are recorded in coincidence with fission fragments which are detected using multi-wire proportional count ers mounted inside a 1 m diameter SS target chamber. The detectors and electronics have been tested off-line using radioactive sources and the results are presented.Pramana 11/2014; 83(5):807-815. DOI:10.1007/s12043-014-0872-9 · 0.65 Impact Factor
Article: Measurement of evaporation residue excitation functions for the F-19+Pt-194,Pt-196,Pt-198 reactions[Show abstract] [Hide abstract]
ABSTRACT: Experimental measurements of evaporation residue (ER) cross sections for the F19 + Pt194,196,198 reactions forming Fr213,215,217 compound nuclei are reported. The cross sections are measured at beam energies in the range of 101–137.3 MeV. The survival probability of the Fr213 compound nucleus with neutron number N=126 is found to be lower than the survival probabilities of Fr215 and Fr217 with neutron numbers N=128 and 130 respectively. Statistical model analysis of the ER cross sections show that an excitation energy dependent scaling of the finite-range rotating liquid drop model fission barrier is necessary to fit the experimental data. The fitted scaling factors for Fr213 are found to be smaller than those of Fr215 and Fr217 for almost the entire range of excitation energies.Physical Review C 02/2014; C 89,:024609. DOI:10.1103/PhysRevC.89.024609 · 3.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background: Synthesis of a doubly magic spherical nucleus beyond 82208Pb126 is a key question in contemporary nuclear physics. Such nuclei can exist solely because of shell stabilization. As the formation cross section of super heavy elements is prohibitively low, attempts have been made to understand stabilizing effects of closed proton (Z) and neutron (N) shells in the vicinity of 82208Pb126. Purpose: The present work attempts to elucidate the stabilizing effect of shell closure, in general, and the same of Z=82, in particular. Methods: The evaporation residue (ER) excitation function and ER-gated γ-multiplicity distribution have been measured for the reaction 31P + 170Er at a laboratory energy range of 134–172 MeV. The measurements have been carried out using the HYbrid Recoil mass Analyzer (HYRA) in gas-filled mode and a 4π spin spectrometer consisting of 29 NaI(Tl) detectors. Results of the present reaction have been compared with those of the reaction 30Si + 170Er. Statistical model calculation has been performed for both the systems. Results: The two reactions, induced by 30Si and 31P projectiles, resulted in compound nuclei (CN) 200Pb (Z=82) and 201Bi (Z=83), respectively. To reproduce experimental ER cross sections, the liquid drop fission barrier (Bf) had to be scaled in the statistical model calculation. The scaling factor (Kf) varies from 0.75 to 1.05 and 0.90 to 1.05 for 30Si and 31P induced reactions, respectively. No significant differences have been found between γ-multiplicity distribution and the distribution moments of the two systems. Conclusions: No clear signature has been observed in favor of extra stability of the ERs with closed proton shell (Z=82) as Kf values of the two systems match within errors. More exclusive measurements and comparison between more systems forming CN/ER around Z=82 are desirable.Physical Review C 09/2013; 88(3). DOI:10.1103/PhysRevC.88.034606 · 3.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Evaporation Residue (ER) gated gamma-multiplicity was measured for the reaction 30Si + 170Er which formed the compound nucleus (CN) 200Pb. The measured multiplicity distribution was compared with those of two other reactions, viz, 16O + 184W and 19F + 181Ta forming the same CN. Further, experimental results were compared with statistical model calculations. Both comparisons indicate an absence of higher spins in ERs for 30Si + 170Er compared to the other two more asymmetric reactions. This lowering of spin value is attributed to non-compound fission.Nuclear Physics A 10/2012; 890-891:62-76. DOI:10.1016/j.nuclphysa.2012.07.004 · 2.20 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Evaporation residue cross sections for the reaction 16O+194Pt were measured at beam energies in the range 75.4–103.1 MeV using the gas-filled separator Hybrid Recoil Mass Analyzer at the Inter University Accelerator Centre, New Delhi. The transmission efficiency of the separator was obtained using the calibration system 16O+184W and a Monte Carlo simulation code. Measured evaporation residue cross sections were fitted with statistical model calculations using Kramers' formula. The present measurement provides further evidence for the onset of dissipative forces in fission in the mass ∼200 region.Physical Review C 01/2012; 84(6). DOI:10.1103/PhysRevC.84.064606 · 3.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The Hybrid Recoil mass Analyzer (HYRA) operated in gas-filled mode has recently been coupled with the TIFR 4pi spin spectrometer at IUAC, New Delhi to carry out spin (or angular momentum) distribution of heavy residues from fusion-evaporation reactions and spin gated GDR measurements. The details of the combined facility, initial experiments on evaporation residue tagged gamma-multiplicity and the extraction of average transmission efficiency of HYRA are elaborated.The European Physical Journal Conferences 10/2011; 17. DOI:10.1051/epjconf/20111714003
Article: Indian National Gamma Array at IUAC[Show abstract] [Hide abstract]
ABSTRACT: Indian National Gamma Array (INGA) is a 4π multi-detector gamma-ray spectrometer based on twenty four Compton-suppressed Clover Germanium detectors with a total photo peak efficiency ~ 5 %. INGA was designed to perform high resolution gamma-ray spectroscopy to study nuclear structure at high spins with stable ion beams at Inter University Accelerator Centre (IUAC). Description of the facility and performance of the array are presented in this paper. Since its commissioning, a number of nuclear spectroscopic investigations have been carried out using the array.Journal of Physics Conference Series 09/2011; 312(5):052015. DOI:10.1088/1742-6596/312/5/052015
Article: Angular momentum distribution for the formation of evaporation residues in fusion of 19F with 184W near the Coulomb barrier[Show abstract] [Hide abstract]
ABSTRACT: We present γ-ray multiplicity distributions for the formation of evaporation residues in the fusion reaction 19F+184W→20383Bi120 at beam energies in the range of 90–110 MeV. The measurements were carried out using a 14 element BGO detector array and the Heavy Ion Reaction Analyzer at the Inter University Accelerator Centre. The data have been unfolded to obtain angular momentum distributions with inputs from the statistical model calculation. Comparison with another neighboring system, viz. 19F+175Lu→19480Hg114 with nearly similar entrance-channel mass asymmetry, hints at the depletion of higher angular momenta after crossing of the Z=82 shell in the compound nucleus.Nuclear Physics A 01/2011; 850(1):22-33. DOI:10.1016/j.nuclphysa.2010.12.004 · 2.20 Impact Factor
- The European Physical Journal Conferences 01/2011; 17:16011. DOI:10.1051/epjconf/20111716011
Article: Entrance channel effect for CN 200Pb[Show abstract] [Hide abstract]
ABSTRACT: The spin distribution of Evaporation Residues (ER) was measured for the reaction Si-30 + Er-170. ER spin distributions were compared for the systems (160) + W-184, F-19 + Ta-181 and Si-30 + Er-170 forming the Compound Nucleus Pb-200. Mean gamma multiplicity vs. excitation energy curve shows saturation at a lower value in case of Si-30 + Er-170. This was attributed to non compound nuclear processes.The European Physical Journal Conferences 01/2011; 17:16007. DOI:10.1051/epjconf/20111716007
- [Show abstract] [Hide abstract]
ABSTRACT: A 4π multi-detector gamma-ray spectrometer named the Indian National Gamma Array (INGA) has been set up at the Inter University Accelerator Centre, New Delhi, for nuclear structure studies. The array is designed to incorporate twenty four Compton-suppressed Clover germanium detectors with a total photopeak efficiency ∼5%. The spectrometer along with sub-systems developed in-house like, mechanical support structure, high voltage power supplies, automatic liquid nitrogen filling system, front-end electronics and data acquisition system are described. The mechanical support structure facilitates the use of the Clover Germanium array with a recoil mass separator. The array has been used in a number of nuclear spectroscopic investigations. The in-beam and off-beam performance of the array are reported.Nuclear Instruments and Methods in Physics Research Section A Accelerators Spectrometers Detectors and Associated Equipment 10/2010; 622(1):281-287. DOI:10.1016/j.nima.2010.06.200 · 1.22 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Hybrid recoil mass analyzer (HYRA) is a unique, dual-mode spectrometer designed to carry out nuclear reaction and structure studies in heavy and medium-mass nuclei using gas-filled and vacuum modes, respectively and has the potential to address newer domains in nuclear physics accessible using high energy, heavy-ion beams from superconducting LINAC accelerator (being commissioned) and ECR-based high current injector system (planned) at IUAC. The first stage of HYRA is operational and initial experiments have been carried out using gas-filled mode for the detection of heavy evaporation residues and heavy quasielastic recoils in the direction of primary beam. Excellent primary beam rejection and transmission efficiency (comparable with other gas-filled separators) have been achieved using a smaller focal plane detection system. There are plans to couple HYRA to other detector arrays such as Indian national gamma array (INGA) and 4π spin spectrometer for ER tagged spectroscopic/spin distribution studies and for focal plane decay measurements. KeywordsFusion-heavy evaporation residues-gas-filled separator-recoil mass spectrometer-momentum achromatPramana 10/2010; 75(2):317-331. DOI:10.1007/s12043-010-0119-3 · 0.65 Impact Factor
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ABSTRACT: Quasielastic scattering angular distributions have been measured for the 7Be + 9Be system at E lab = 17 , 19 and 21MeV in the angular range qcm \theta_{{cm}}^{} = 24° - 57° . An optical model (OM) analysis of these data has been carried out in order to extract optical potential parameters and reaction cross-sections. One-proton stripping cross-sections were also measured for this system at E lab = 19 and 21MeV. These transfer angular-distribution data were compared with the finite-range distorted-wave Born approximation (FRDWBA) calculations. For the 7Li + 9Be system quasielastic scattering angular distributions were measured and emitted light charged particles were detected at E lab = 15.75 , 24.00 and 30.00MeV in the angular range qcm \theta_{{cm}}^{} = 7° - 70° . Fusion cross-sections were obtained by reproducing the measured a \alpha -evaporation spectra from the compound nucleus at backward angles with the statistical model calculations. The ratios of the experimental fusion cross-sections to the total reaction cross-sections (obtained from OM analysis) were found to be small. This result suggests that the break-up process has a strong influence on the fusion process leading to a reduction in the fusion cross-section.European Physical Journal A 06/2010; 44(3):385-392. DOI:10.1140/epja/i2010-10966-2 · 2.74 Impact Factor
Article: Channel coupling effects on the fusion excitation functions for Si-28+Zr-90,Zr-94 in sub- and near-barrier regions[Show abstract] [Hide abstract]
ABSTRACT: Fusion excitation functions and angular distributions of evaporation residues (ERs) have been measured for 28Si+90,94Zr systems around the Coulomb barrier using the recoil mass spectrometer, Heavy Ion Reaction Analyzer (HIRA). For both systems, the experimental fusion cross sections are strongly enhanced compared to the predictions of the one-dimensional barrier penetration model (1-d BPM) below the barrier. Coupled channels formalism has been employed to theoretically explain the observed sub-barrier fusion cross section enhancement. The enhancement could be explained by considering the coupling of the low-lying inelastic states of the projectile and target in the 28Si+90Zr system. In the sub-barrier region, the measured fusion cross sections for 28Si+94Zr turned out to be about an order of magnitude higher than the ones for the 28Si+90Zr system, which could not be explained by coupling to inelastic states alone. This observation indicates the importance of multinucleon transfer reaction channels with positive Q values in the sub-barrier fusion cross section enhancement, because 90,94Zr are believed to have similar collective strengths. This implies that no strong isotopic dependence of fusion cross sections is expected as far as the couplings to collective inelastic states are concerned. In addition, the role of projectile and multiphonon couplings in the enhancement has been explored.Physical Review C 04/2010; 81(4). DOI:10.1103/PhysRevC.81.044610 · 3.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Two large area multistep position sensitive (two dimensional) multiwire proportional counters have been developed for experiments involving study of fission dynamics using general purpose scattering chamber facility at IUAC. Both detectors have an active area of 20x10 cm(2) and provide position signals in horizontal (X) and vertical (Y) planes, timing signal for time of flight measurements and energy signal giving the differential energy loss in the active volume. The design features are optimized for the detection of low energy heavy ions at very low gas pressures. Special care was taken in setting up the readout electronics, constant fraction discriminators for position signals in particular, to get optimum position and timing resolutions along with high count rate handling capability of low energy heavy ions. A custom made charge sensitive preamplifier, having lower gain and shorter decay time, has been developed for extracting the differential energy loss signal. The position and time resolutions of the detectors were determined to be 1.1 mm full width at half maximum (FWHM) and 1.7 ns FWHM, respectively. The detector could handle heavy ion count rates exceeding 20 kHz without any breakdown. Time of flight signal in combination with differential energy loss signal gives a clean separation of fission fragments from projectile and target like particles. The timing and position signals of the detectors are used for fission coincidence measurements and subsequent extraction of their mass, angular, and total kinetic energy distributions. This article describes systematic study of these fission counters in terms of efficiency, time resolution, count rate handling capability, position resolution, and the readout electronics. The detector has been operated with both five electrode geometry and four electrode geometry, and a comparison has been made in their performances.The Review of scientific instruments 12/2009; 80(12):123502. DOI:10.1063/1.3263911 · 1.61 Impact Factor
Conference Paper: Measurement of fusion excitation functions around the Coulomb barrier 28Si+90,94Zr systems.International Symp. On Nucl. Phys; 01/2009
Conference Paper: Evaporation residue measurements for 16O+194Pt reaction at energies around the Coulomb barrier using HYRA.International Symp. On Nucl. Phys.; 01/2009
Article: Measurements of elastic scattering for 7Be, 7Li + 9Be systems and fusion cross sections for 7Li + 9Be system[Show abstract] [Hide abstract]
ABSTRACT: Elastic scattering angular distributions have been measured for 7Be + 9Be system at Elab = 17, 19 and 21 MeV in the angular range θcm=26○–58°, and for 7Li + 9Be system at Elab= 15.75, 24 and 30 MeV. An optical model (OM) analysis of these data have been carried out. For the 7Li + 9Be system fusion cross sections were obtained at Elab = 15.75, 24 and 30 MeV by measuring the α-evaporation spectra from the compound nucleus at backward angles. The measured α-evaporation spectra were reproduced by the statistical model calculations and fusion cross sections were extracted therefrom. The ratios of the experimental fusion cross sections to the total reaction cross sections (obtained form OM analysis) were found to be rather small. This result suggests that break-up process has a strong influence on fusion process leading to a reduction in fusion cross section.The European Physical Journal Special Topics 01/2007; 150(1):75-78. DOI:10.1140/epjst/e2007-00270-0 · 1.40 Impact Factor
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Inter University Accelerator CentreNew Dilli, NCT, India


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Could you give a pointer to the documentation that describes this motiona accurately? I've not been able to find one, yet.
'gn' motion not implemented yet
emacs 24.3.1 evil 1123
the 'gn' motion is one of the newer ones added, i think around 7.3.500. it remembers the last searched pattern. so if you
/foo<cr>. you can then
cgnbar<esc> and it will search until the next foo and replace it with bar. and since this is repeatable, you can hit
. and it will search/replace the next foo.
Comments (18)
the vim documentation is actually pretty scarce on this, but you can find mention of it in the motion.txt document.
"Also see gn and gN, operating on the last search pattern."
"dgn 'delete the next search pattern match'"
- changed status to open
As long as there's not reasonable official documentation and my vim does not support the command (so I can test), I would prefer to not include these commands. However, I've prepared a patch you can test.
- attached gn.patch
- attached gn.gif
after applying your patch it's not quite working for me. i've attached a gif of how the
gnmotion can be used with
doperators, as well as repeating. i hope that makes it a bit clearer how the motion is used.
i also did a search of the vim docs, and it looks like the visual.txt document contains the most information about gn.
ok, so seems like the major difference between vim and evil is that vim will change the word under the cursor, so i did a minor hack to make it work over here:
(evil-define-text-object evil-next-match (count &optional beg end type) "Select next match." (unless (eq evil-search-module 'evil-search) (error "next-match text objects only work with Evil search module.")) (evil-ex-search-previous 1) (evil-ex-search-next count) (list evil-ex-search-match-beg evil-ex-search-match-end))
undoing isn't exactly the same yet (on some occasions it takes 2 undoes when it should be one), and the highlighting gets out of sync, but i can live with that for now. thanks.
I would like to add my support for this feature, as a vimmer transitioning to emacs.
vim emphasizes commands and motions. You press a key for a command, then a motion for what to operate on. Then, these command snippets can be easily repeated. gn and gN allow operating on search/regex matches instead of simple motions like w. The lack of this feature was painful in vim as well (there have been quite a few hackish workarounds), and its recent addition was met with rejoicing.
Here's the relevant vim documentation on gn and gN for reference:
*gn* *v_gn* gn Search forward for the last used search pattern, like with `n`, and start Visual mode to select the match. If the cursor is on the match, visually selects it. If an operator is pending, operates on the match. E.g., "dgn" deletes the text of the next match. If Visual mode is active, extends the selection until the end of the next match. *gN* *v_gN* gN Like |gn| but searches backward, like with `N`.
This screencast explains the feature in great details:
FWIW, i've been using the snippet since it was revealed until now and it continues to work great. also, it seems that some other upstream fixes have addressed the undo discrepancy, so now both evil and vim take the same number of undos to get back to the same place. the
gUgnexample from vimcasts works as well.
- changed status to resolved
gNtext objects (fix
→ <<cset ead85adff777>>
- changed status to open
just tested on a 'make terminal' off of the tip.
create a new file:
. hello hello hello hello
- go to line 1 and search for 'hel', enter.
- cgnfoo, esc
rather than searching to the next and replacing, it will actually go to the last line. if you repeat again it will zig zag back to the 2nd hello and replace it.
- changed status to resolved
evil-next-matchagainst search wrap (fix
evil-next-matchhas to do a backward search first in order to determine whether point is on a match, currently. However, this search must not wrap at the buffer boundaries.
→ <<cset 637573c60835>>
works great! thanks for the quick turnaround.
Having had a look at this I've hit into:
(error "next-match text objects only work with Evil search module."). looking at my
evil-search-modulevalue I have isearch. I can not find this anywhere in my configuration files, do you need to set up
You can customize the variable
evil-search-module, i.e. press
M-x customize-variable RET evil-search-mode RET.
gNtext objects (fix
→ <<cset ead85adff777>>
evil-next-matchagainst search wrap (fix
evil-next-matchhas to do a backward search first in order to determine whether point is on a match, currently. However, this search must not wrap at the buffer boundaries.
→ <<cset 637573c60835>>
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Reviews, reviews, reviews...
FreakScore is a weighted average of all aggregated professional and user review scores.
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This product has a FreakScore of 7.5
out of 10 based on 38 scores.
It's difficult to imagine how you could improve the humble CD pl
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Best Price at Amazon


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Water Quality Association Develops Sustainability Mark
Monday April 22nd, 2013 - 10:31AM
These are shortcuts to your favorite social networking and bookmark sites. Add this story to your Facebook page, del.icio.us, DiggIt, and many others!
To build water quality and environmental awareness, the Water Quality Association launched its Sustainability Mark at the WQA Aquatech USA convention earlier this month. It will first focus on suppliers of activated carbon, as well as filtration products that use activated carbon.
Products that meet the requirements of these new standards and receive certification will be authorized to display the new WQA Sustainability Mark.
The standard for filtration devices that use activated carbon will be available beginning this month, while the standard for activated carbon will be available in coming months. WQA will also begin offering certification to the existing ISO 14001: Sustainable Management Systems Standard as it applies to production facilities.
Efforts are underway to add product categories for sustainability certification, including reverse osmosis, UV purifiers and filtration products that include non-carbon media. End point devices, softeners, ion exchange media, distillers and other products are also on the horizon.
The standards will be available according to product category, and will operate on a points-based system, giving manufacturers a choice from a menu of sustainability advancing criteria.
For more water filtration category developments, see the upcoming HomeWorld April 29, 2013, issue.
Tags: • Housewares • Home Environment • Sustainability • Trade Shows •
Walmart Appoints Biggs CFO, Bratspies U.S. Merchandising Chief »
Newell Rubbermaid Makes Leadership Team Changes
NPD Survey Finds Consumer Mood Brighter Heading Into Holidays
O'Gorman Appointed President Of HoMedics
Frontgate Partners With Donatella Arpaia For Holiday Tableware
NRF Predicts Modest Holiday Sales Growth
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The holiday season must be approaching, because retailers are adding items to their wish lists. I don't mean the products expected to be big sellers during the fourth quarter. I'm referring to new demands by retailers to their suppliers for fees, price allowances and other hands-tying arrangements.


text: TSM/Chris Arsenault Alien Bug Found in Westport, MA [VIDEO] By Gazelle July 31, 2015 Help! I found an alien bug and I have no clue what it is or where it came from! Read More Category: Animals, Community, Local Stuff, TSM, Videos, Weird News Tags: alien, Alien Bug, Alien Insect, Bug, Bug Found In Kitchen, chris arsenault, fun 107, Fun Morning Show, Gazelle, Gazelle's Mother, Insect, kitchen, massachusetts, westport, Westport Massachusetts Send to a friend! Share on Facebook Share on Twitter Pin it! Reddit This! Share on Tumblr!


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- Titans CB Jason McCourty ready for season debut vs. Bills Updated: Oct-08-15 5:55 pm
NASHVILLE, Tennessee - Titans cornerback Jason McCourty finally is ready for his season debut Sunday, even though the veteran hasn't taken a hit harder than what teammates muster up in padded practices.
- Titans showing signs of running well with trio in backfield Updated: Oct-07-15 6:11 pm
NASHVILLE, Tennessee - Bishop Sankey took his turn in the season opener, Dexter McCluster was up next in Cleveland and Antonio Andrews followed up against Indianapolis.
- Players zipping around locker room on latest must-have craze Updated: Sep-24-15 2:17 am
NASHVILLE, Tennessee - Titans defensive lineman Jurrell Casey zips out of the locker room on a motorized board heading to a meeting. San Francisco nose tackle Ian Williams rides around, stops to toss shoes into his locker and then hops right back on.


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How long have you been on DeviantArt?
5 years
What does your username mean?
This is the name of the first character I created. It represents me and what I want to be in a magic world in a side but in the other side it's not.
Describe yourself in three words.
Stressed learning artist
Are you left or right handed?
Right handed
What was your first deviation?
It's when you see the first and compare to the others that you see the evolution.
What is your favourite type of art to create?
Paintings. When you paint, you don't need a computer and if you have the stuff you can do it everywhere witout any kind of software to help you. You are in front of something you have to do without any photoshop. It's more than a simple work it's a traditional work and a way to prouve that what you learned with a software and a computer can be done with traditional stuff.
If you could instantly master a different art style, what would it be?
Animation. I think this is one of the most complicated woks you can do when you limit yourself to patings or digital art. You have more difficult works like scupture but for me it's a big chalenge to animate something.
What was your first favourite?
What type of art do you tend to favourite the most?
Well seeing my faves now, only 9 pages compared to some deviants is nothing. I have a lot of winx fan arts but I think the things I will fave the most now will be the saint seiya (orginal series (not the others >.<)) fan arts or cosplays.
Who is your all-time favourite deviant artist?
??? It will be dificult to answer, each one has his own style. I like all of them and even if I don'ty comment if or fave it. I see them and there evolutions.
If you could meet anyone on DeviantArt in person, who would it be?
Humm... Two of them first because she is amazing I spent a lot of time at phone with her but for moment we can't meet each other, I hope it will be possible.
The second one I want to see her in person, maybe one day.
How has a fellow deviant impacted your life?
It's a good way to fire stress and escape in an other world.
What are your preferred tools to create art?
Humm... I would say my pencils but if the price of acrylic was not soo expensive it would definitly be brushes.
What is the most inspirational place for you to create art?
My room. It's where I get the best ideas ans the worst too.
It's the place where I sleep, the place where I can dream, imagine other worlds an other life.
What is your favourite DeviantArt memory?
I think tha it was the first big gift someone gave me, without any reson, just for me, it's this one :


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Showing 1-2 of 2 Nature Resorts
Bartwood Lodge
One look at the ocean and mountains from Bartwood Lodge will tell you it's perfect for nature-based excursions. Moran State Park, Mt. Constitution, Cascade and Mountain Lakes are all within easy distance; whale and eagle watching tours abound here!... more
Turtleback Farm Inn
Reconnect with nature by crossing the road from the Inn and exploring the Turtleback Mountain Preserve. Encompassing 1,576 acres of forest, grasslands and Garry Oak woodlands, its high meadows and rocky ledges lead way to unparalleled views of the San Juan and Canadian Gulf Islands. This stunning destination is sure to lure back nature-lovers year... more
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Jan 19, 2012
Thanks to its pan regional presence and ability to raise
both domestic and hard currency financing, the Spanish bank
participated in a broad range of infrastructure financings
through loans, international bonds, and innovative local
Improving infrastructure and finding ways to finance this
has become vital...
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Oct 21 - 22, 2015 | Grand Hyatt, Playa del Carmen, México
SFLA will convene in Playa del Carmen, Mexico the most important issuers and investors from across...
Will a strong dollar deter investors from LatAm bonds?
No, the yield-hunt goes on
Yes, but only retail investors
Yes, once the Fed raises rates
There was indeed a risk of losing investment grade, but thanks to the appointment of Joaquim Levy and the new fiscal targets, that risk has declined a lot
Ilan Goldfajn, Itaú-Unibanco
All material is subject to strictly enforced copyright terms & conditions and cannot be repurposed or reproduced. © 2015 Latin American Financial Publications Inc.


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Nick Foles throws 3 TDs as Eagles drub injury-plagued Packers
GREEN BAY, Wis. -- A deflected pass that landed in DeSean Jackson's hands. Two long touchdowns to Riley Cooper, one after a defensive back slipped to leave the Eagles receiver wide open for a score.
Good things happen with Nick Foles at quarterback for the Eagles.
A week after tying the NFL record by passing for seven TDs, Foles connected for three long scores and Philadelphia pulled way for a 27-13 victory Sunday over the injury-ravaged Green Bay Packers.
"He has great poise," Cooper said. "He's going to sit in the pocket and kind of dissect the defense."
Foles equaled marks by Peyton Manning, who did it earlier this season, and Milt Plum (1960) with 16 TD passes without throwing any interceptions.
Philadelphia's 17-point third quarter handed Green Bay its first back-to-back home losses since 2008, Aaron Rodgers' first season as the starter. It was the worst home loss for the Packers since falling 38-10 to the New York Jets on Dec. 3, 2006.
The Eagles improved to 5-5, with all their victories coming away from Philly. They won a test of attrition at Lambeau Field on Sunday.
The undermanned Packers (5-4) played most of the day with third-string quarterback Scott Tolzien. Rodgers is out with a left collarbone injury, and backup Seneca Wallace left after the first series with a groin injury.
Actually, Tolzien played well considering he was just signed off the practice squad this week. He finished 24 of 39 for 280 yards with a touchdown and two interceptions.
"We had a lot of tough situations today, no excuses," coach Mike McCarthy said. "I thought Scott Tolzien played as well as could be expected."
Foles was better.
He finished 12 for 18 for 228 yards and the three scores -- a 55-yarder to Jackson and touchdowns of 45 and 32 yards to Cooper. Foles still hasn't thrown an interception this season, and the Pro Football Hall of Fame has requested a game-worn jersey and cleats that Foles wore during his record-tying, seven-TD performance against Oakland.
It could be tough for Michael Vick to get his starting job back any time soon. He was inactive a second straight week with a hamstring injury.
LeSean McCoy finished with 155 yards on 25 carries, the second straight week that Green Bay's run defense had allowed a 100-yard rusher. McCoy softened the Packers with runs of 9 and 25 yards on the Eagles' first series of the second half before Foles found Cooper for the 45-yard score and a 17-3 lead.
When safeties creep into the box to stop the run, "you've got to be able to throw the ball over the top," coach Chip Kelly said. "We've got some guys in DeSean and Coop that can go over the top that we believe in."
The strong-armed Foles exposed Green Bay's secondary in the second half. Cooper was wide open on both of his scores, rolling over the goal line on his 45-yarder after being untouched on the ground, then working his way free toward the left sideline after Morgan Burnett slipped for the 32-yard score to make it 27-10 with 10 seconds left in the third quarter.
Whether it's Lambeau or Oakland Coliseum, the Eagles succeed on the road (5-1). The only blemish was a 52-20 loss in Denver. They're still squarely in the race in the mediocre NFC East.
"We're not good at home and we're good on the road. We better figure it out because we're coming home," Kelly said.
Tolzien, who played college ball at Wisconsin, seemed at ease. He zipped a 22-yard pass to Brandon Bostick with 3:22 left in the third quarter to cut the Eagles' lead to 20-10. The Eagles answered on their next drive with the second of Cooper's two scoring catches.
Tolzien's biggest mistake came early in the second quarter, when he marched the Packers from their 18 into the red zone, only to be intercepted by Brandon Boykin in end zone on an underthrown ball to Jordy Nelson. At the time, the Eagles were only leading 7-0.
"We had an awesome opportunity there and got a good look with the play that we were running," Tolzien said. "Looking back on the throw, I should have thrown more back pylon."
Cooper finished with three catches for 102 yards, while Jackson had four catches for 80 yards. He caught his 27th career touchdown of 55 or more yards.
ESPN Fan Shop Powered By
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Survey says: Stephen Gostkowski is the best kicker in the league
Stephen Gostkowski of the New England Patriots is the best kicker in the NFL, according to an NFL Nation survey of his peers.
Coach Bill O'Brien won't commit to starting QB after loss to Colts
For the second time this season, Texans coach Bill O'Brien is considering an in-season quarterback change.
Ex-Texan Andre Johnson scores first two touchdowns as Colts beat
Receiver Andre Johnson picked the perfect time to catch his first touchdown as a member of the Indianapolis Colts.
Arian Foster taken to locker room in 2nd quarter after hard hit
Texans running back Arian Foster was taken to the locker room in the second quarter of Thursday night's 27-20 loss to the Colts with an unspecified injury.
Dolphins fire D-coordinator Kevin Coyle, name Lou Anarumo replacement
The Miami Dolphins fired defensive coordinator Kevin Coyle on Thursday after four seasons with the team and promoted defensive backs coach Lou Anarumo to take his place.
Jay Cutler says he'll tough it out for injury-ravaged Bears
Jay Cutler said on Thursday he's not 100 percent but is pushing through his hamstring discomfort in light of all the injuries the Bears have suffered this year.
2015 NFC East Standings
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Does this restaurant serve Indian food?
Is this restaurant good for breakfast?
Is this restaurant good for large groups?
Is this restaurant family-friendly?
Is this restaurant good for dinner?
Does this restaurant accept reservations?
Is this restaurant good for lunch?
Is this restaurant good for local cuisine?
Is this restaurant good for brunch?
Does this restaurant offer takeout or food to go?
Thanks for helping!
Nice ambiance, nice food! You get good options in buffet too! If you miss eating at a dhaba, you may get the feel there but paying the bill, will surely not give the same feel!
Ambiance is very cool, for the first time visitors its quite interesting and they enjoy the place and food.
nice food, clean n hygenic... staff courteous. Multicuisines, bar, well located. Overall We rates good.
Excellent food and service. Staff was very helpful. Quick service. What I like most is the music and ambiance that one would like to have for a lovely dinner. It is bit expensive but over all excellent.
Dhaba food in a very urban and neat setting.
Food is good and the service very prompt.
Nice place for a relaxed meal.
Good to go for typical dhaba style ambiance and wonderful fried biryani.Love the 80's posters around.
Great Indian food with village dhaba feel under air condition. Great hospitality, good taste and value for money. Worth a dinner.
The look of the restaurant is a typical punjabi setting. Offers Buffet in Lunch and its worth your money. Definitely will suggest to visit once.
Awesome North Indian food. Loved their pindi cholle. The ambiance of dhaba has been nicely created and adds to your fine dining experience.
at banjara hills in hyderabad this place is good for value.food is average .place is given an ethnic look.north indian food in hyderabad is difficult to get but what you get here is not really what you wanted
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text:
CANNES, FRANCE (AP) - If Shia LaBeouf has his way, this year's Cannes Film Festival is just a beginning.
After previous trips to the festival with blockbusters "Transformers" and "Wall Street: Money Never Sleeps," LaBeouf is here with his first film in competition, the Prohibition-era "Lawless," as well as a short he directed, "Howard Cantour.com."
"Smaller hotel room, but a lot more pride," he said in an interview shortly before "Lawless" was to make its premiere Saturday.
In "Lawless," directed by John Hillcoat, LaBeouf stars as the younger, less violent brother of a trio of Appalachia bootlegging brothers (Tom Hardy, Jason Clarke) protecting their backwoods freedom from a savage lawman from Chicago (Guy Pearce).
The film, to be released by the Weinstein Co. this fall, is a clear departure for LaBeouf, whose young career has been more dominated by franchise action films than character-driven genre work like "Lawless."
"I've made a lot of movies about plot and device," says LaBeouf. "Now, I find myself being attracted to _ and being allowed to make _ more movies about people and characters."
Coming to Cannes for the 25-year-old LaBeouf, whose manner is intense and direct, is also something of a return to the scene of a crime. In 2010, he disparaged two of his own blockbusters _ "Transformers: Revenge of the Fallen" and "Indiana Jones and the Kingdom of the Crystal Skull" _ a severe break with Hollywood etiquette _ particularly when the directors concerned are Steven Spielberg and Michael Bay.
"Cannes is a big part of my learning curve," he says. "I've lost friends. I've experienced extreme heartbreak here."
LaBeouf also drew from his past in Cannes for "Howard Cantour.com," which stars comedian Jim Gaffigan as a film critic. Though LaBeouf has now directed several shorts and music videos, he says he plans to keep making shorts before trying his hand at directing a feature.
"Lawless," adapted by Australian musician Nick Cave from Matt Bondurant's 2008 historical novel, "The Wettest County in the World," was in Hollywood purgatory for two years after losing studio backing, a period through which LaBeouf remained committed to the film.
The attraction, LaBeouf says, was Hillcoat, whose 2005 Australian western "The Proposition" _ for which Cave composed the soundtrack _ he admires.
"He has sensibilities closer to my sensibilities than my previous commanders," says LaBeouf. "When a man says to you, `I'm planning to make "Goodfellas" in the woods,' it's really hard to get away from that idea."
Hillcoat praised the more adult performance for LaBeouf.
"He's actually very nuanced and incredibly subtle and very real," says Hillcoat. "There's a real tenderness, as well. For him, it was something that he's been dying to do for some time."
The film drew mixed reviews at Cannes after screening for the media Saturday, but generally positive ones for its performances. The film blog IndieWire wrote that the movie "will silence (LaBeouf's) critics."


text:
Anonymous comments allowed.
Reply+22#21 - doigboiger (01/13/2013) [-]
As a proper Norfolk-boy I feel threatened by all these crazy hippie teas.
What's wrong with PG-Tips, milk and two sugars?
What's wrong with PG-Tips, milk and two sugars?
Reply-1#26 to #21 - jamsammich (01/13/2013) [-]
I'm from Norfolk too :)
Reply0#22 to #21 - holeymoley [OP](01/13/2013) [-]
some people just want more to their tea, i do have PG tips most of the time but sometimes i want something with more OOMPH
that makes sense right?
that makes sense right?
Reply0#23 to #22 - doigboiger (01/13/2013) [-]
I'm sure it does. But all I want is nice hot brew.


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BYU Football: Scheduling changes looming for BYU football's 2013 season
Jeffrey D. Allred, Deseret News
PROVO — While attending West Coast Conference basketball media day festivities Monday in Los Angeles, BYU athletic director Tom Holmoe had football on his mind.
Of course, football is never far from his mind.
Holmoe enjoyed chatting with the league's basketball coaches and other administrators at the event, but he is dealing with recent setbacks involving the 2013 football schedule.
"It's not even done," Holmoe told the Deseret News at the WCC meetings. "I've been working on games today."
Two contests that the Cougars were planning on for next season, including one that was already contracted, have fallen through recently, he said.
"I see teams that schedule games for 2020 and 2021. I'm like, 'Oh my goodness, would that be nice?' I've got to get the 2013 schedule done."
Such is the life of an athletic director of an independent football program — particularly at BYU.
"There are some things that have changed in the schedule," he said. "When you're an independent, things change."
Change seems to be the operative word.
The Cougar football team, which is idle this week, has posted a lackluster 5-4 record this season — including three losses by a combined total of seven points. BYU has three games against Western Athletic Conference opponents remaining and needs one more victory to become bowl-eligible. The Cougars are slated to play in the Poinsettia Bowl in San Diego — with former Mountain West Conference rival San Diego State a likely opponent.
Naturally, Holmoe was relieved after BYU pounded Georgia Tech, 41-17, last weekend in Atlanta, but he acknowledged that it's been difficult to watch this season unfold.
"It takes its toll on everyone," Holmoe said. "It's frustrating, no more so than for the coaches and players. And the fans are a big part of what we're doing. They're frustrated that we lost games that we were in, and could have won, in ways that we normally don't lose games."
Next year's schedule has been billed as the toughest in school history. And, as a result of the Cougars' performance in 2012, Holmoe said he expects some shakeups in the football program before 2013.
"This is a team that, I think the expectations were high. Sometimes our media (BYU media relations) and the local media, in an effort to pub the season, some players and some units on our team were made to look better than they really were," Holmoe said. "The expectations were really, really high with a pretty competitive schedule. And we certainly didn't live up to that.
"I want to be a really great team. I'm a football guy, but I don't think there was a time when I thought, 'We're going to win the national championship this year.' You could see some of our troubles early. We've addressed some of them, but some of them aren't going to change this year. It's been an eye-opening experience for some of our players and coaches to be able to see and say, 'Oh, OK, that's what we need to do.' I think there will be some changes that take place between this year and next year that will help our team in many ways, in different aspects, from technical details to things that will be noticeable. It will be good."
Those changes could impact the coaching staff, and Holmoe said that's something he and coach Bronco Mendenhall will address when the season ends. Clearly, there have been problems on the offensive side of the ball this year. Holmoe added that there have been some chemistry issues on the staff, adding that being successful isn't just about talent. "There are intangibles in football," he said.
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